This project is designed to develop operative and non-operative regimens to improve both the duration and quality of life of patients with cirrhosis. Our major objective is to study the physiologic and clinical results of a new therapeutic concept, selective variceal decompression, while maintaining hepatic portal flow. Early studies of this new operation, selective distal splenorenal shunt, have documented accomplishments never before achieved. Long-term studies are of great importance to ascertain if the impressive early results can be sustained. These include control of bleeding, markedly lowered incidence of encephalopathy and prevention of increased rate of delayed hepatic failure. Equally important studies of portal-systemic encephalopathy are elucidating the ammonia release potential of individual amino acids, groups of amino and whole proteins and correlating this with maximal urea synthesizing capability. These factors are then analyzed as to their encephalopathic potential in both shunted and non-shunted cirrhotic patients. Similar data are obtained to contrast the selective versus total portal-systemic shunt procedures. The possibility of substituting alpha-keto analogues of the essential amino acids is also being studied.